Sonder Diabetes Wellness (HMO C-SNP)

Georgia Chronic Condition Special Needs C-SNP Plan (2024 Plan)


Monthly Premium

Your Cost
$0
by Sonder Health Plans, Inc.

Additional Coverage

HearingVisionDental

Overall Government Star Rating

No Rating (new plan)

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Plan Name
Sonder Diabetes Wellness (HMO C-SNP)
Insurance Carrier
Sonder Health Plans, Inc.
Plan Type
Chronic Condition Special Needs Plan (C-SNP)
Network Type
HMO

Sonder Diabetes Wellness (HMO C-SNP) is a Chronic Condition Special Needs Plan (C-SNP), which is available in Georgia and offered by the health insurance company Sonder Health Plans, Inc.. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$3,850
Primary doctor visit
$0 copay
Specialist visit
$0 copay
ER visit
$120 copay per visit (always covered)
Ambulance
$225 copay

Sonder Diabetes Wellness (HMO C-SNP) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $3,850 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Sonder Diabetes Wellness (HMO C-SNP) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Sonder Diabetes Wellness (HMO C-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Sonder Diabetes Wellness (HMO C-SNP) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Sonder Diabetes Wellness (HMO C-SNP) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Limited coverage
Home and bathroom safety devices
Not covered
Meals for short duration
Limited coverage
Annual physical exams
Not covered
Telehealth
Limited coverage

Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$3,850 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
$0 copay
Specialist visit
$0 copay

Tests, labs, & imaging

Diagnostic tests & procedures
$0 copay
Lab services
$0 copay
Diagnostic radiology services (like MRI)
$0-275 copay
Outpatient x-rays
$0 copay
Emergency care
$120 copay per visit (always covered)
Urgent care
$25 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
$350 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage
$280 copay per visit

Skilled nursing facility

Skilled nursing facility
$0 per day for days 1 through 20
$184 per day for days 21 through 100

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
$225 copay

Therapy services

Occupational therapy visit
$40 copay
Physical therapy & speech & language therapy visit
$40 copay

Mental health services

Outpatient group therapy with a psychiatrist
$40 copay
Outpatient individual therapy with a psychiatrist
$40 copay
Outpatient group therapy visit
$40 copay
Outpatient individual therapy visit
$40 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
20% coinsurance per item
Prosthetics (like braces, artificial limbs)
20% coinsurance per item
Diabetes supplies
$0 copay

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic$0.00 copay


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$0 copay

Brand-name drugs :
$0 copay

Generic$15.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier33%

Part B Drugs

Chemotherapy drugs
0-20% coinsurance
Other Part B drugs
0-20% coinsurance

Hearing

Hearing exam
$30 copay
Fitting/evaluation
Not covered
Hearing aids - All types
$699-999 copay

Preventive Dental

Oral exam
$0 copay
Cleaning
$0 copay
Fluoride treatment
$0 copay
Dental x-rays
$0 copay

Comprehensive dental

Non-routine services
$0 copay
Diagnostic services
$0 copay
Restorative services
$0 copay
Endodontics
$0 copay
Periodontics
$0 copay
Extractions
$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services
$0 copay

Vision

Routine eye exam
$0 copay
Contact lenses
$0 copay
Eyeglasses (frames & lenses)
$0 copay
Eyeglass frames (only)
Not covered
Eyeglass lenses (only)
Not covered
Upgrades
Not covered

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